Our experience with orthopedic surgery in hemophiliacs

Abstract

Introduction Patients having severe hemophilia (levels of deficient factor below 1%) frequently suffer from disabling chronic arthropathy. An adequate substitution treatment using the coagulation factor VIII or IX concentrates renders an elective surgery feasible.

Objective The objective of the study was to check the results of different surgical procedures in the treatment of hemophilic arthropathies, and to propose the best protocol of their treatment.

Methods This is a retrospective study on 26 hemophilic patients operated in the Orthopedics and Trauma Clinic II, Timişoara, from 2002 to 2005. Elective surgical procedures were mainly performed in the knee (21 arthroscopic procedures, 1 open arthrodesis), elbow (2 open synovectomies, 2 radial head excisions), ankle (1 arthroscopic synovectomy and debridement) and thigh (1 giant pseudo tumor excision, other minor procedures). The results after operations on moderate and severe chronic knee, elbow and ankle arthropathy were evaluated, with approximately 24-month follow-up period.

Results Arthroscopic procedures (22) yielded good and satisfactory results with significant improvement according to the evaluation criteria recommended by the World Hemophilia Federation (Gilbert clinical score, Pettersson radiological score, Nuss MRI score).

Conclusion Mini-invasive elective surgery in moderate to severe chronic arthropathy produces good results when performed in a specialized centre and with multi-disciplinary approach.

Keywords: hemophilia; knee; synovectomy; arthroscopy; chronic arthropathy